Predictors of 90-Day Functional Outcome Following Direct Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion: A Prospective Study

Abstract

Background: Mechanical thrombectomy (MT) is becoming a growing trend in the management of large vessel occlusion (LVO) during the past few decades, although data on the predictors of outcome following MT are scarce. We aimed to study the predictors of 90-day outcome in a cohort of patients with ischemic stroke with large-vessel occlusion. Methods: This was a three-month prospective study of 40 patients with anterior circulation LVO who underwent MT and were followed up for three months with modified Rankin Score (mRS). Results: Of the 40 patients recruited, 55% were men. M1 was the most common vessel occluded (32.5%) followed by internal carotid artery (ICA) and carotid trunk (20%). Tandem occlusion occurred in 25% of the cases. Among the demographic, clinical, radiological, and procedural variables studied, the factors that had a significant impact on the mRS at 3 months were age, diabetes mellitus (DM), hyperlipidemia, stroke mechanism, blood glucose level during procedure, post-procedural National Institutes of Health Stroke Scale (NIHSS), baseline Alberta stroke program early CT score (ASPECT) score, collaterals grade, and procedural thrombolysis in cerebral infarction (TICI) score (P<0.05). On multivariate regression, patients’ age (B: 0.025, 95% CI: 0.001- 0.049, P=0.038), post-procedural NIHSS (B: 0.192, 95% CI: 0.101–0.283, P<0.001), and baseline ASPECT score (B: -0.442, 95% CI: -0.838- -0.046, P=0.03) were the most independent factors to affect the mRS at 3 months. Conclusion: Patients’ age, baseline ASPECT score and post-procedural NIHSS are significant predictors of 90-day outcome of large-vessel occlusion following MT.